美沙酮治疗成人慢性非癌性疼痛。
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Haroutiunian S, McNicol ED, Lipman AG
美沙酮治疗成人慢性非癌性疼痛。
Cochrane Database Syst Rev. 2012 11月14日;11:CD008025。cd008025.pub2 doi: 10.1002/14651858.。
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23152251 (PubMed视图］
- 摘要
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背景:美沙酮属于一类被称为阿片类镇痛药，被认为是治疗因危及生命的疾病引起的中重度疼痛的基石;然而，它们在慢性非癌性疼痛(CNCP)中的应用存在争议。美沙酮具有许多与其他阿片类药物不同的特征，这表明它可能具有不同的疗效和安全性。目的:评价美沙酮治疗CNCP的镇痛效果和安全性。检索方法:我们通过检索Cochrane图书馆2011年第11期的Cochrane中央对照试验登记(Central)， MEDLINE(1950 - 2011年11月)和EMBASE(1980 - 2011年11月)，以及检索到的论文和评论的参考文献列表，确定了美沙酮用于慢性疼痛的随机对照试验(rct)和非随机研究。选择标准:我们纳入了以疼痛评估为主要或次要结果的随机对照试验。准随机研究、队列研究和病例对照试验也被考虑纳入，因为我们怀疑美沙酮在CNCP中的有益和有害影响可能在rct中没有得到充分的解决。数据收集和分析:两篇综述作者独立提取疗效和不良事件数据并评估偏倚风险。主要结果:我们纳入了两项随机对照试验和一项非随机研究，共涉及181名参与者。两项rct均为交叉研究，其中一项涉及19名患有不同神经性疼痛综合征的参与者，另一项涉及76名患有带状疱疹后神经痛的参与者。 Study phases were 20 days and approximately eight weeks, respectively. The non-randomized study retrospectively evaluated 86 outpatients over an average of 8.8 +/- 6.3 months.One RCT reported average pain intensity and pain relief, and found statistically significant improvements versus placebo for both outcomes, with 10 mg and 20 mg daily doses of methadone. The second RCT reported differences in pain reduction between methadone and morphine and found morphine to be statistically superior. The non-randomized study found that in patients initially prescribed methadone it was effective in fewer participants than in those initially prescribed other long-acting opioids (28% versus 42%, 33% and 50% for morphine, oxycodone and transdermal fentanyl, respectively).One RCT compared incidences for several individual adverse events, but found a difference between methadone and placebo for only one event, dizziness (P = 0.041). AUTHORS' CONCLUSIONS: The three studies provide very limited evidence of the efficacy of methadone for CNCP, and there were too few data for pooled analysis of efficacy or harm, or to have confidence in the results of the individual studies. No conclusions can be made regarding differences in efficacy or safety between methadone and placebo, other opioids, or other treatments.
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